Community HealthChoices Explained By CAROLINE SMITH
More than 420,000 Pennsylvanians have transitioned into Community HealthChoices. Does this affect you or someone you care for? Chances are it does, and below is a guide on what this means for them. Community HealthChoices (CHC) has been a hot topic across Pennsylvania for the last three years as a new statewide mandate came out changing the way we provide care and services to those in need, especially the elderly with low incomes, those in long-term nursing facilities, and adults with chronic physical disabilities. Changes occurred to our statewide Medicaid program, the services that can be received, and how they are being implemented. This new initiative has rolled out across the state of Pennsylvania in three phases beginning in 2018 (southwest), 2019 with the second phase (southeast), and the last phase in January 2020 (middle of the state — this was the largest geographical area). Community HealthChoices is Pennsylvania’s mandatory managed-care program for adults 21 and older who are eligible for both Medicaid and Medicare, older adults, and those receiving long-term supports and services through physical disability waivers, now known as the CHC waiver. If someone you care for meets one or more of these qualifications, they have been automatically enrolled in CHC. There are several exceptions — people who will not be enrolled into CHC even if they meet the criteria above. These exceptions are those in a state-operated hospital, such as a veterans hospital, and those approved for Office of Developmental Program waivers, such as the consolidated waiver or person/family-directed services, LIFE program, and autism waiver, as well as those in the Act150 program or those in the OBRA waiver. There are three managed care organizations (insurance companies) that are overseeing the state and the services provided under CHC. These insurance companies include PA Health & Wellness (Centene), AmeriHealth Caritas/Keystone First, and UPMC for You. These insurance companies are responsible to coordinate services and take the confusion out of your care. If someone you care for is enrolled in CHC, they will be asked to choose one of these “plans” or insurance companies.
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